Independent validation of the ICU requirement score in a cohort of acutely poisoned adults.
Clin Toxicol (Phila)
; 56(7): 664-666, 2018 07.
Article
en En
| MEDLINE
| ID: mdl-29143551
ABSTRACT
OBJECTIVE:
To independently validate the predictive value of the intensive care requirement score (IRS) in unselected poisoned patients.DESIGN:
Retrospective chart review. PATIENTS ANDMETHODS:
Five hundred and seventeen out of 585 admissions for acute intoxications could be analyzed. Eleven were excluded for a condition already requiring intensive care unit (ICU) support at admission (e.g., preclinical intubation). A further 57 admissions were excluded due to missing data. The IRS was calculated using a point-scoring system including age, Glasgow Coma Scale, heart rate, type of intoxication, and preexisting conditions. It was then compared to a composite endpoint indicating an ICU requirement (death in hospital, vasopressors, need for ventilation). The endpoint and the point-scoring system were identical to the original publication of the score. RESULTS ANDCONCLUSION:
Twenty-three out of 517 patients had a complicated clinical course as defined by meeting the endpoint definition. Twenty-one out of 23 complicated courses had a positive IRS (defined as greater or equal 6 points), as compared to 255/494 patients with an uncomplicated clinical course (p < .001, Fisher's exact test). One patient (with a positive IRS) died. The negative predictive value of the IRS was 0.99 (95% CI 0.97-1), the sensitivity was 0.91 and the specificity 0.48. In conclusion, the IRS is significantly linked to outcome. While a negative IRS virtually excludes the need for ICU care, a positive IRS has a positive predictive value too low to be used for risk stratification. The IRS could also be applied to unselected admissions of poisoned patients.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Intoxicación
/
Unidades de Cuidados Intensivos
Tipo de estudio:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adolescent
/
Adult
/
Aged
/
Aged80
/
Female
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Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Clin Toxicol (Phila)
Asunto de la revista:
TOXICOLOGIA
Año:
2018
Tipo del documento:
Article
País de afiliación:
Alemania